Provider Demographics
NPI:1730133729
Name:OHIO STATE UNIVERSITY
Entity Type:Organization
Organization Name:OHIO STATE UNIVERSITY
Other - Org Name:OSU TRAUMATIC BRAIN INJURY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-293-2594
Mailing Address - Street 1:700 ACKERMAN ROAD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-293-2594
Mailing Address - Fax:614-293-4487
Practice Address - Street 1:2050 KENNY ROAD
Practice Address - Street 2:SUITE 330
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212
Practice Address - Country:US
Practice Address - Phone:614-685-8511
Practice Address - Fax:614-685-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
6707Medicare UPIN